One major cause for gynecomastia revision surgery is when too much of the male breast tissue has been removed leaving what is known as a “crater deformity”. A crater deformity is as it sounds a crater or depression under the nipple/areola complex with the inadequate blending of surrounding tissue for a firm smooth contour.
How to Correct a Crater Deformity
Fortunately, there are procedures that can correct the crater deformity. First, the patient must wait until he has completely healed from the original surgery. In general, the fat flap is the best choice and has become the most predictable; this is where the skin is elevated and the fat that surrounds the crater is sewn together filling in the depression. Sometimes the use of fat injections also known as fat transfer or fat grafting can take place but it all depends on the architecture of the defect.
Find a Board Certified Plastic Surgeon
It is important for the gynecomastia patient to find an experienced Board Certified Plastic Surgeon. A secondary procedure is much more difficult due to scar tissue that has formed which makes the dissection more difficult and healing less predictable. In addition to the complication of scar tissue, the skin usually does not contract as well as the first time around. I would say that 35% to 40% of my gynecomastia procedures are revision surgeries.
See video of “post-surgery” in a blog dated April 2, 2012.
Gynecomastia is an overgrowth of tissue on the male chest which is a combination of fatty tissue as well as the normal glandular tissue found in men and women. Obesity can lead to a predominance of the fatty portion of gynecomastia whereas other causes can lead to an overgrowth of the normal glandular breast tissue found in both genders. There are numerous causes of gynecomastia. Anabolic steroid use including those found over the counter without a prescription and legally sold in health food stores such as GNC, multiple prescription medications for unrelated conditions, marijuana usage, but most commonly there is no identifiable cause. Heavy alcohol use and liver conditions can also lead to gynecomastia. Gynecomastia is extremely common at the onset of puberty, and the majority of these cases reverse themselves within a year and a half.
When gynecomastia has been present for two years or longer, it is extremely unlikely to reverse itself. In this situation, surgery is indicated to relieve the unsatisfactory appearance as well as the, sometimes, encountered painful cases of gynecomastia.
Surgery for this condition formerly was not a very satisfactory one for either the surgeon or the patient. This required an incision around the border of the areolae from the 3 to 9 o’clock positions with direct excision of the tissue under direct vision by the surgeon with scissors often leading to an irregular or lumpy final result. It also required drainage tubes coming out of the sides of the torso. Most of all, however, was the appearance of two half-moon scars on the chest, which no man cares to display for the rest of his life.
This changed with the advent of ultrasonic liposuction some 10 years ago. Traditional liposuction is ineffective in removing any of the glandular components of this condition. Remember, there are two components that need to be reduced and that is the fatty tissue as well as the glandular tissue. Whereas traditional liposuction may be able to remove a portion of the fatty tissue, it takes the power of ultrasonic liposuction to have an appreciable effect.
Ultrasonic liposuction involves the use of a cannula made of titanium whose tip vibrates over 20,000 times per second. The tissue that encounters this leading probe cannot tolerate the rapid positive and negative pressure waves, and the resulting cavitation effect causes the breakdown of the tissues. This allows for more breakdown of the fatty and glandular tissue of the chest wall. Nevertheless, even ultrasonic liposuction cannot remove all of the tissue, and this is where we have an instrument that can be inserted through the small incision under the arm to remove the rest of the glandular tissue. Having said all this, the result is we can offer for most patients an operation with no scar or incision on the chest, no drainage tubes, and only a small 1.5cm incision under each arm to remove the tissue and result in a flatter, more masculine torso. Since the fatty tissue and the glandular tissue are removed, the chances of recurrence are extremely unlikely and would depend on continued stimulation from some source such as described above. Just as important as getting a flat torso is not removing too much tissue. Certainly, some glandular tissue in a small amount has to be left behind by the nipple and areola so that a depression is not left behind.
I hope this has been helpful to you. Please write down questions for your gynecomastia consultation as they arise as our staff is always anxious to help you in educating you about your condition as well as the solutions we can offer.
For personalized information about gynecomastia plastic surgery procedures, please complete Dr. Delgado’s inquiry form.
BREAST CANCER INCIDENCE IN ADOLESCENT MALES UNDERGOING SUBCUTANEOUS MASTECTOMY FOR GYNECOMASTIA.
IS PATHOLOGICAL EXAMINATION JUSTIFIED?
AUTHUR: John Koshy, M.D. from the location of plastic surgery, Baylor College of Medicine and the Department of Pathology.
REVIEW OF ARTICLE:
This is a question that every surgeon asks himself when removing tissue from the human body. This tissue such as fat from liposuction or excised skin from a face-lift or tummy tuck is not at issue but any abnormal tissue becomes a question. Is it justified to send gynecomastia tissue pathology in men under 21 years old is this the question asked by this article?
John Koshy, M.D., at Baylor performed a retrospective or three major hospitals in Texas from 1999 to 2010 looking at the tissue pathology of patients less than 21 years old. They also performed a literature review from 1965 to 2010 of men less than 21 years old who underwent male breast reduction for gynecomastia. In addition, they did an informal survey of 61 major children’s hospitals across the country if gynecomastia tissue was routinely sent to pathology.
Gynecomastia Pathology results:
The ten-year review of 81 patients of men less than 21 years old revealed no cases of breast cancer. The quota cost for the pathology was $1,260.00 as the out-of-pocket cost.
LITERATURE REVIEW
2,000 articles were reviewed. There were only 36 articles to discuss cases of adolescent Gynecomastia. Over a 35-year period, 615 cases were examined. The average age of the patient being 17 years old. The pathology revealed six cases of cancer.
INFORMAL SURVEY
22 of 61 hospitals gave responses in 18 states either routinely performed or required histological exam of gynecomastia of breast tissue excised from men with gynecomastia.
CONCLUSION FROM THE STUDY:
The incidence of abnormal pathology in adolescent men is rare. There seems to be little benefit in the routine histological exams, and the current policy and procedures should be reviewed.
Based on this study, routine microscopic exams of men 21 years of age or less should not be routinely done or required. This can be performed when desired by the patient, patient’s family, or managing physician.
gynecomastia.psstage.com does not give advice or options to try to produce educational and permission for its readers.
Reviewed by,
Miguel Delgado, M.D.
www.gynecomastiaspecialist.com
